Radiology Coding Alert

Don’t overlook pertinent details that don’t involve new, revised, or deleted codes.

With the huge influx of new, revised, and deleted ICD-10-CM codes coming your way this year, it’s in your best interest to dedicate a reasonable amount of time to getting to know all the most important details respective to the radiology specialty. The problem, as most radiology coders already know, is that nearly every implemented change to the 2021 ICD-10-CM could conceivably apply on any given encounter.

While the prospect of addressing all the ICD-10-CM changes for 2021 may seem daunting, it’s not an insurmountable task.

Kick-start the transition to the new year now by highlighting some of the most important changes to the 2021 ICD-10-CM manual.

Note Extensive Arteriosclerosis Index Revisions

If you’re used to coding scans of the arterial vessels, such as a computed tomographic angiographies (CTAs) or magnetic resonance angiographies (MRAs), then you’re probably acutely aware of the vast array of arteriosclerosis diagnoses available within the ICD-10-CM alphabetic index and tabular. Well, as of 2021, that list of arteriosclerosis codes will be expanding to include chronic limb-threatening ischemia (CLTI), or critical limb ischemia (CLI). CLI is an advanced stage of arterial occlusive disease of the limbs, often referred to as end-stage or terminal stage.

Fortunately, you won’t have to worry about the introduction of any brand-new codes for CLI reporting. Instead, the ICD-10-CM index has included over 100 new routes to existing arteriosclerosis codes to accommodate for this condition, but you shouldn’t have too much difficulty reaching the correct area of the alphabetic index so long as you know where to look. Beginning at Arteriosclerosis, arteriosclerotic (diffuse) (obliterans) (of) (senile) (with calcification) I70.90 ⇒ with, you’ll encounter some of the following sub-terms:

• Chronic limb-threatening ischemia - see Arteriosclerosis, with critical limb ischemia;
• Critical limb ischemia.

Under critical limb ischemia, you’ll code from there the highest degree of specificity. For instance, if the dictation report documents a CLI of an autologous vein bypass graft of the right leg with gangrene, you’ll report code I70.461.

Add Increased Specificity to CSF Leak Dxs

A comprehensive list of new codes added to category code G96 (Other disorders of central nervous system) is another area that’s sure to have a profound impact on diagnostic radiology. With respect to cerebrospinal fluid (CSF) leaks, reporting using the current ICD-10-CM manual begins and ends at G96.0 (Cerebrospinal fluid leak). In 2021, unspecified CSF leaks will be reported as G96.00 (Cerebrospinal fluid leak, unspecified). However, you’ll also have the option of reporting more specified forms of CSF leaks:

• G96.01 (Cranial cerebrospinal fluid leak, spontaneous)
• G96.02 (Spinal cerebrospinal fluid leak, spontaneous)
• G96.08 (Other cranial cerebrospinal fluid leak)
• G96.09 (Other spinal cerebrospinal fluid leak)

Note: Keep in mind that many new code additions also include parenthetical notes located in the tabular, such as “Use additional,” “Excludes,” and “Code also.”

Category code G96 includes a few more crucial additions to the ICD-10-CM index that you need to be aware of when coding spinal scans. Specifically, these changes will impact your coding of conditions affecting the spinal meninges. First, you’ll find that code G96.19 (Other disorders of meninges, not elsewhere classified) will convert to G96.198 (same code descriptor). Next, you’ll now have the option of reporting the following code for documented perineural cysts:

• G96.191 (Perineural cyst)

Note: You’ll also see in the tabular that you should report G96.191 when the documentation includes any of the following:

• Cervical nerve root cyst;
• Lumbar nerve root cyst;
• Sacral nerve root cyst;
• Tarlov cyst; and
• Thoracic nerve root cyst.

Introduce Yourself to This Set of Intracranial Hypotension Codes

Next, get acquainted with the following set of codes specific to subcategory code G96.81 (Intracranial hypotension):

• G96.810 (Intracranial hypotension, unspecified)
• G96.811 (Intracranial hypotension, spontaneous)
• G96.819 (Other intracranial hypotension)

You’ll find an extensive list of “Code also” notes underneath subcategory code G96.81 to consider for any of the above three diagnoses. For instance, if intracranial hypotension is accompanied by a stroke or a cerebrospinal fluid leak from the spine, you’ll report the following respective codes as secondary diagnoses:

• I63.- (Cerebral infarction)
• G96.02 (Spinal cerebrospinal fluid leak, spontaneous) — also new in 2021.

Include Documentation of Esophageal Bleeding With K20 Codes

Finally, turn your attention to a new set of codes featured in the Diseases of the digestive system (K00-K95) chapter. Coding for esophagitis was previously limited to a set of three codes, two of which being K20.8 (Other esophagitis) and K20.9 (Esophagitis, unspecified). ICD-10-CM will add another degree of specificity in 2021 by including documentation of with or without bleeding:

• K20.90 (Esophagitis, unspecified without bleeding)
• K20.91 (Esophagitis, unspecified with bleeding)

The same concept applies to gastro-esophageal reflux disease (GERD) coding under K21.0 (Gastro-esophageal reflux disease with esophagitis). In 2021, you’ll be required to document whether the GERD includes bleeding with the following codes:

• K21.00 (Gastro-esophageal reflux disease with esophagitis, without bleeding)
• K21.01 (Gastro-esophageal reflux disease with esophagitis, with bleeding).